From the Guidelines
Management of osteoarthritis (OA) of the thumb should prioritize a combination of non-pharmacological and pharmacological treatment modalities individualized to the patient's requirements, with a focus on education, exercises, and orthoses, as well as topical and oral analgesics, according to the most recent guidelines 1.
Key Recommendations
- Education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient with hand OA, as recommended by the 2018 update of the EULAR guidelines 1.
- Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient with hand OA, with a focus on thumb strengthening exercises and proper joint mechanics 1.
- Orthoses, such as splints, should be considered for symptom relief in patients with thumb base OA, with long-term use advocated for optimal benefit 1.
- Topical treatments, including topical NSAIDs, are preferred over systemic treatments due to safety reasons and should be the first pharmacological topical treatment of choice for hand OA 1.
- Oral analgesics, particularly NSAIDs, should be considered for a limited duration for relief of symptoms in patients with hand OA, with doses as low as possible and treatment continued for as short a time as possible 1.
Treatment Approach
The treatment approach for OA of the thumb should be individualized according to the patient's specific needs, taking into account factors such as the localization of OA, risk factors, type of OA, presence of inflammation, severity of structural change, level of pain, disability, and restriction of quality of life, as well as comorbidity and co-medication 1.
Surgical Intervention
Surgical intervention, such as trapeziectomy, arthrodesis, or arthroplasty, should be considered for patients with structural abnormalities when other treatment modalities have not been sufficiently effective in relieving pain, as recommended by the 2018 update of the EULAR guidelines 1.
Intra-Articular Injections
Intra-articular injections of glucocorticoids should not generally be used in patients with hand OA but may be considered in patients with painful interphalangeal joints, as recommended by the 2018 update of the EULAR guidelines 1.
From the Research
Management of Osteoarthritis of the Thumb
- The management of osteoarthritis of the thumb is based on clinical assessment, with early disease treated with rest, anti-inflammatory agents or analgesics, intraarticular steroid injections, and splints 2.
- Numerous options and controversies exist for surgical treatment of carpometacarpal joint arthritis, with fewer options available for metacarpophalangeal joint arthritis, and surgical treatment for interphalangeal arthritis mainly being arthrodesis 3.
- Conservative treatment of thumb base osteoarthritis includes hand therapy, which may reduce pain, and intra-articular injections of steroid or hyaluronate, which can provide pain relief, with hyaluronate being more effective 4.
- The use of orthoses can reduce pain without affecting function, strength, or dexterity, with various types of orthoses being used and follow-up times varying from 2 weeks to 7 years 4.
- A systematic review and network meta-analysis found that all splints were superior to placebo in reducing pain intensity, with the top-ranked intervention being the rigid CMC-MCP splint, and the short thermoplastic CMC splint being the best treatment to increase function 5.
- Current UK practice in secondary care for the management of osteoarthritis at the base of the thumb involves the use of non-surgical treatments such as hand therapy, splints, and intra-articular injections, with surgical procedures including simple trapeziectomy and trapeziectomy with ligament reconstruction and/or tendon interposition 6.